When a person struggling with substance abuse puts down the drink or drug after long-term use, detoxification – sometimes called detox, stabilization, or medically managed withdrawal – provides the addicted person with help through the acute physical symptoms of withdrawal that occur when an addict or alcoholic abruptly stops using. During detox, medical and addiction professionals monitor the health of their patient, manage and ease physical discomfort or suffering, provide encouragement and support, and – ideally – guide the addict or alcoholic into a long-term rehab program.

— Just as a little side note to clarify the vocabulary: any time an alcoholic or drug addict (especially an opiate addict) slowly or abruptly stops using – whether voluntarily or due to circumstances – the addict will experience some form of withdrawal. When a person addicted to drugs or alcohol seeks professional help for the symptoms of withdrawal, the process is called detox. So the alcohol or drug detox process always involves withdrawal but withdrawal doesn’t always involve detox. —

Drug or alcohol detoxification is a necessary first step down the road to recovery from addiction, but it’s crucial that we understand detoxing is only the beginning. Because drug addiction and alcoholism are chronic, life threatening diseases that require life-long management, recovery is a marathon rather than a sprint. And as a beginning to that marathon, prescription drug or alcohol or opiate detoxification is the part where a marathon runner puts on the sneakers.

The Center for Disease Control states that “Participation in outpatient or residential programs for less than 90 days is of limited or no effectiveness.” You can access the CDC article here.

Reader Alert: Linked sources are important to me because they allow the reader to judge the credibility of information and to find the original material in order to read further on a topic. But linked sources are also important to me because drug and alcohol addictions – particularly opioid addiction – are life threatening diseases. When I find five prestigious sources that are all saying the same thing, I can trust the information, and I know I’m not being sucked into the latest fads or “popular” approaches that attempt to make money off addiction recovery. Apologies for all the quotes.

And likewise, drug and alcohol detoxification is only as effective as its follow-up care:

The National Institute for Drug Abuse advises that “Medical detoxification is only the first stage of addiction treatment and by itself does little to change long-term drug use.”

The Center on Addiction and Substance Abuse at Columbia University cautions that “Detoxification is an important step in the recovery process, but it is not treatment for the disease.”

The physical symptoms of drug withdrawal are the easiest to spot; to varying degrees withdrawal from cocaine, opiates, and alcohol provokes anxiety, irritability, fatigue, flu-like symptoms, sweating, insomnia, restlessness, muscle aches. Withdrawal from opiates can also include stomach cramps, diarrhea, nausea, vomiting, chills, and cold sweats. (In fact, the goosebumps caused by these cold sweats led to the expression “going cold turkey.”)

These physical symptoms of drug withdrawal cause discomfort and suffering, but that suffering ends within days or within a few weeks. It’s the silent symptoms — the psychological, emotional, neurological, biochemical, and mental ramifications of detoxification from drugs and alcohol – particularly heroin — that kill. And they kill cruelly, because addicts are at their greatest risk just as hope has emerged upon successful completion of detox.

Cocaine withdrawal often has no visible physical symptoms like the vomiting and shaking that accompany the withdrawal from heroin or alcohol. However, the level of craving, irritability, delayed depression, and other symptoms produced by cocaine withdrawal rivals or exceeds that felt with other withdrawal syndromes. Because cocaine produces a sense of extreme joy by causing the brain to release higher than normal amounts of some biochemicals, when cocaine use is stopped or when a binge ends, a crash follows almost immediately. This crash is accompanied by a strong craving for more cocaine. Suicide in response to the crash or unintentional overdose in response to the intense craving are very real risks.

The National Institute for Drug Abuse warns that after the physical symptoms of opiate withdrawal resolve, a general depression, or dysphoria (opposite of euphoria), may last for weeks, increasing the risk of suicide, self-harm, or relapse. But the biggest post-detox complication is return to drug use. Most opiate overdose deaths occur in people who have just withdrawn or detoxed. Because withdrawal reduces tolerance to the drug, those who have just gone through withdrawal can overdose on a much smaller dose than they used in the past.

The British Journal of Medicine published results of a horrifying study that determined:

“Patients who ‘successfully’ completed inpatient detoxification were more likely than other patients to have died within a year. No patients who failed to complete detoxification died. Heroin addicts are known to have excess mortality. However, on the basis of previously published data we would have expected that in our group only one or two patients would have died within a year and only one from overdose. The clustering of the deaths from overdose in the group of patients who had successfully completed treatment is counterintuitive and illogical—unless it derives from loss of tolerance and consequent unpredictability of resumed heroin use.”

The article, “Loss of Tolerance and Overdose Mortality after Inpatient Opiate Detoxification: A Follow-up Study,” can be accessed here.

The State of New York isn’t surprised that people die after detox. Its Office of Alcoholism and Substance Abuse Services bluntly states:

“When a long-term opiate addicted patient relapses and uses illicit opiates after a detox episode, he/she is at increased risk for accidental overdose death, since the detox experience can reduce the individual’s opiate tolerance.

Post-detox risk includes depression, self-harm, relapse, suicide, overdose, making an immediate transfer from detox to long-term addiction care all the more imperative.

STAYING THE COURSE

Just as putting on the sneakers is an important first step in running a marathon, detoxification from drugs and alcohol is an important first step in running the marathon of recovery from addiction. But a marathon runner without a pre-planned, mapped course can’t complete a marathon unless he/she just follows the other runners. When heroin and synthetic opioid addicts finish detox, they need a pre-planned recovery route to follow. Without it, they’ll just follow the other addicts to the closest dealer. The CDC recommends long term treatment. We shouldn’t assume that a medical detox will arrange that long term treatment for the addict we love. Even if a medical detox facility is partnered with a 28 day drug and alcohol rehab program, long term rehab of at least 90 days is the path experts most recommended — a path not just to recovery, but to safety from relapse – the kind of relapse that leads to unintentional overdose and death.

Republished with permission from “When We Love An Addict: The Cost of Addiction”